Mercadante S
Palliat Med. 1999 Mar;13(2):95-104. doi: 10.1191/026921699678158579.
Morphine metabolites are involved in various ways in determining the complex effects of morphine, both favourable and adverse, and may complicate the clinical use of morphine in the treatment of cancer pain. The production and effects of the principal morphine metabolites, morphine-3-glucuronide and morphine-6-glucuronide, in both normal and pathological states have been reviewed in the current literature. Therapeutic implications are also reviewed on the basis of experimental and clinical reports. The presence of these metabolites should be recognized in the chronic treatment of cancer pain with morphine, especially in the presence of renal impairment, and should be considered to have an important influence on opioid responsiveness, defined as a balance between the achievement of an optimal analgesia and the occurrence of adverse effects.
吗啡代谢产物以多种方式参与决定吗啡的复杂作用，包括有利和不利的作用，并且可能使吗啡在癌症疼痛治疗中的临床应用复杂化。目前的文献综述了主要吗啡代谢产物吗啡 - 3 - 葡萄糖醛酸苷和吗啡 - 6 - 葡萄糖醛酸苷在正常和病理状态下的产生及作用。还根据实验和临床报告对其治疗意义进行了综述。在使用吗啡长期治疗癌症疼痛时，尤其是存在肾功能损害的情况下，应认识到这些代谢产物的存在，并且应考虑它们对阿片类药物反应性有重要影响，阿片类药物反应性定义为达到最佳镇痛效果与出现不良反应之间的平衡。
